0474: The deleterious cardiovascular impact of renal failure varies according to PCI indication - 07/02/15
Résumé |
Aim |
To compare cardiovascular (CV) outcomes after contemporary PCI in patients with vs. without renal failure (RF) according to clinical presentation (ST-elevated myocardial infarction (STEMI), acute coronary syndrome (ACS), and stable coronary artery disease (sCAD)).
Methods |
Consecutive patients undergoing PCI with stent implantation were prospectively included from 2007 to 2012. RF was defined by a CrCl <60ml/min. The primary end-point was all cause-mortality. The secondary endpoints were MACCE (cardiovascular death, myocardial infarction, stroke, TLR), TLR (target lesion revascularization), and ARC definite/probable stent thrombosis (ST) at one year.
Results |
Among 5337 patients eligible, 1219 (23%) had PCI for STEMI, 1837 (34%) for ACS and 2281 (43%) for sCAD. There were 1441 (27%) patients with RF. At one year, patients with RF had increased all-cause mortality rates whatever the indication for PCI (Figure), with a 6 fold higher unadjusted all-cause mortality rate in STEMI patients (41% vs. 7.5%) and a 3 fold increase in ACS (19% vs. 6%) and sCAD (10% vs. 3%) patients compared to noRF patients (p< 0.0001 for all comparisons). MACCE were also higher in RF patients in each PCI indication (45% vs. 15% in STEMI, 23% vs. 14% in ACS, and 14% vs. 9% in sCAD, p<0.05 for all). STEMI-noRF patients had comparable mortality (p=0.209) and MACCE rates (p=0.658) than sCAD-RF patients. TLR ranged from 5.5% to 7.4%, and definite/probable ST was <2.5% without any difference in each PCI indication (p>0.05 for both). After multivariable analyses, RF was independently associated with an excess of death with a more than doubled relative risk in STEMI compared to ACS and sCAD patients (OR 5.3: CI 3.627-7.821 in STEMI vs. 2.1: CI 1.465-3.140 and 2.3: CI: 1.507-3.469 in ACS and sCAD, respectively, p<0.0001).
Conclusion |
RF is a stronger independent predictor of death after PCI in patients with STEMI compared to patients with ACS and sCAD. CV prognosis of sCAD-RF patients was found to be comparable to that of STEMI-noRF patients.
Le texte complet de cet article est disponible en PDF.Vol 7 - N° 1
P. 3 - janvier 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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